Endoleak after aneurysm surgery? Don't worry, let's talk about it!

You've probably just come home from a major surgery. You're probably feeling a great sense of freedom and relief. But did the doctor tell you about something like 'endoleak'? Or did he tell you that something like that could happen when you come for future check-ups? It's normal to feel a little scared and worried when you hear this word. But don't worry. Today, we'll talk about it in simple terms, what it is, why it happens, and whether you should be afraid.

Simply put, what is this endoleak?

To understand this, let's first remind you a little about the surgery you had. The largest blood vessel in our body, the aorta, is like the main water pipe in our house. Sometimes, a spot in the wall of this vessel becomes weak and bulges like a balloon. That's what we call an aneurysm . Because this can be dangerous, doctors insert an artificial blood vessel, called a stent graft, into the bulge. Think of it like putting a new, stronger tube through an old, weakened water pipe. Now the blood flows only through the newly inserted stent. Then, there's no pressure on the old, weakened wall, so there's no risk of it bursting. But, after a very short time , a little blood starts to leak between the newly placed stent and the wall of the old blood vessel. It's like a little water leaking from the sides of the new tube. That blood leak is what we medically call an 'endoleak'. If this endoleak occurs within 30 days of surgery, it's called an "early endoleak." If it occurs after 30 days, it's called a "late endoleak."

Does this happen to many people? Is it something to be afraid of?

In fact, about one in four people who undergo these types of aneurysm repair surgeries (such as EVAR or TEVAR) have some chance of developing this endoleak. So it's not that uncommon. But the important thing is, not all endoleaks are dangerous. Therefore, the severity is determined by the type and location of this.

What are the main types of endoleaks?

There are 5 main types of endoleaks. Each of them has a different cause. Now, with the advent of new stent technology, the incidence of some types has decreased significantly. Let's take a look at what these types are.

What are the symptoms of an endoleak?

Here's the most important thing you need to know. Most of the time, you won't feel any symptoms of an endoleak. You may not feel any changes, pain, or discomfort. These are detected during the scans that are done during your follow-up appointments after surgery. That's why your doctor tells you to come in for those scans on the dates they give you. Don't skip them.

Emergency! If you experience these symptoms, go to the ETU immediately!

If the old aneurysm ruptures due to an endoleak, it is a medical emergency. If the following symptoms occur suddenly, do not waste time and go to the nearest hospital's Emergency Department (ETU) .

• Sudden, unbearable, sharp pain in the stomach, back, or legs.
• A sudden, tearing pain in the chest or back.
• Dizziness and fainting.
• Sudden rapid heartbeat .
• Feeling cold and sweating.
• Nausea and vomiting .
• Difficulty breathing .

How do doctors detect this?

As mentioned earlier, this is detected with special scans. These tests may be done during your surgery, after it's done, and months or years later. This is because some late endoleaks can develop after a period of time after surgery. The main tests used are:

• CT scan (Computed Tomography scans): This can take clear three-dimensional images of the inside of the body and check for blood leaks.
• Doppler Ultrasound: This can detect leaks by looking at the pattern and speed of blood flow within blood vessels .
• Angiogram: This involves injecting a special dye into the blood vessels and taking an X-ray to see exactly where the blood is leaking from.

How do you treat an endoleak?

Treatment depends on the type of endoleak you have, where it is located, and your overall health. There is no one-size-fits-all treatment. There are three main options.

1. Observation

This is what is most often done for non-serious endoleaks like Type 2. Your doctor will ask you to have a scan about every 6 months. This will check to see if the blood leak is going away on its own, if it is staying the same, or if the aneurysm is getting bigger. If the aneurysm is not getting bigger, it is best to do nothing and wait.

2. Endovascular Treatment

These are minor surgeries that are performed without a large incision, using something like a needle to go through the blood vessel.

• Embolizing: Blocking small blood vessels that are causing bleeding with a special type of glue or small wires.
• Stent extension: Extending the stent by inserting another piece of stent to cover the leak.
• Applying glue: Sealing the aneurysm by applying a glue-like substance to the area where the blood is leaking.

3. Open Surgery

This is done very rarely. Only if other methods fail to repair the endoleak, and as a last resort, a major surgery involving a stomach incision is resorted to.

Questions to ask your doctor

It's normal to have questions about your condition. Don't hesitate to ask these questions the next time you see your doctor.

• What other complications can occur after this surgery?
• What is my risk of developing an endoleak?
• How often should I come for follow-up?
• What scans do I need to have?
• What should I do to keep my heart and blood vessels healthy?

Repairing an aneurysm is a life-saving procedure. So it's normal to have minor complications like these after such surgery. Most of the time, these don't need to be treated. There are now much more advanced and simple treatments available. If you're feeling tired or overwhelmed, talk to your doctor or family about it. Endoleak, Aneurysm, Surgery, Stent Graft, Blood Leak, Aorta, EVAR, TEVAR, Heart Disease